Totally Tongue-Tied

I was excited to discover
I was pregnant again after trying to conceive for several years. I had
breastfed my two older girls and I was looking forward to nursing my
new son. Kyle was born three days after his scheduled due date, weighing
a modest six pounds, three ounces. We attempted our first nursing experience
in the delivery room, but Kyle was not able to latch on correctly. I
continued to work with Kyle to establish breastfeeding, but whenever
he latched on, it felt as if he was nursing with jaws of steel! He would
clamp down hard, mainly on the nipple. I told the nurse it was far too
painful, and something was wrong with his suck. She told me the lactation
consultants would make their rounds the following day.

I knew I needed help sooner
than that so I called Suzie, my local La Leche League Leader. She was
excited to hear from me and find out Kyle had arrived. I described the problems I was having. She replied, "This sounds a lot like a tight frenulum. Have you checked his frenulum? I wouldn't know what a normal
frenulum (the small band of tissue that connects the underside of the
tongue to the floor of the mouth) looked like if it bit me. He latched on, painfully, while I was on the phone with her, so I figured I'd follow
up with the doctor in the morning. Midway through the night, the pediatrician
made his rounds. I explained to him the difficulties we were having and asked him to check Kyle's frenulum. He told me there was nothing wrong with Kyle's tongue since he could extend it out past his lips.

The lactation consultant
never made it to our room prior to my leaving the hospital, despite
my repeated requests. Since Kyle was latched on when the nurse made
her final rounds in the afternoon, she presumed all was well and discharged
us. Our follow-up, well-baby visit was scheduled for Monday, three days
later.

Over the next few days, Kyle
became a very fussy baby. I was still having a lot of difficulty nursing
him, and latch-on was excruciatingly painful. My right nipple was now
cracked, and he totally refused to take the left side at all, as that
nipple is more flat and difficult to latch on to. I spent most of his
waking hours trying to nurse him and burp him between the screaming.
He was rarely quiet or happy looking. These problems intensified as
my milk came in and I became engorged. I had to syringe-feed Kyle several
times to get anything into him at all, and I was frequently in tears
attempting to console an obviously distressed baby.

Monday finally came, and
I was determined to speak with a lactation consultant. The nurse came
in and weighed Kyle while we were waiting. He had lost six ounces. We
nursed painfully for a bit in the room while waiting. When Martha, the
lactation consultant, finally got to us, I explained to her the problems
we'd been having, especially the excruciating pain with latch-on. Martha
opened Kyle's mouth and became immediately concerned. She then proceeded
to show me how the frenulum had his tongue basically pinned down to the floor of his mouth stating, "No wonder your baby can't nurse properly. He's totally tongue-tied!" I was exasperated, since I'd specifically asked the pediatrician to check this.

The next five hours were a flurry of activities. I was rushed
to the back room to pump off some milk to ease my engorgement. We needed a
way to feed Kyle. He couldn't suck, so Martha brought us some plastic
medicine cups and we poured the milk into his mouth. It was quite
a sight to see this tiny baby drinking from a cup. We gave him two
ounces of expressed human milk from the cup. Kyle was content at this
point and went into a quiet, alert state; eyes open, taking in
the world around him. What a difference from the previous days!

We had his frenulum cut that day. The procedure itself took
only seconds to perform. The nurse practitioner had me nurse Kyle right
afterwards, but he didn't nurse very enthusiastically
so it was difficult to tell if the problem had been corrected. Kyle
started nursing much more frequently throughout the rest of the day,
latching on with less difficulty each time. Over the next couple of
days, nursing was still painful and he remained fairly fussy. My engorgement
was not significantly better, so I kept pumping a few times daily. I
let him nurse, then gave him human milk with a syringe. I put in another
call to the lactation consultant department to let them know we still
had a problem. I waited for the return call to come until, a day and
a half later, sleep deprived and exhausted, I once again called upon
my La Leche League resources. I obtained information regarding a breastfeeding
clinic held daily at one of our local facilities. I took Kyle in first
thing the following morning.

One week and one day after
Kyle was born, his weight had continued to drop. It was now 13 ounces
under his original birth weight. This was more than the 10 percent margin
they allow as normal weight loss after birth. The lactation consultant
at the clinic began working with me to latch Kyle on to nurse. "He has a
lazy, uncoordinated suck," she told me. She was clearly concerned
and wanted to feed him some formula right away. I preferred that formula
not be used. They didn't have a breast pump in the clinic but I was
already leaking and had filled two breast pads, so I hand-expressed
some milk into a medicine cup to feed him. She then showed me how to
syringe feed Kyle while he sucked on my finger. We were to return to
the clinic every day until he began to gain weight while finger-feeding
expressed human milk at home.

The next 24 hours were spent
pumping, nursing Kyle for a minimum of 20 minutes at the breast, and
then finger/syringe feeding an additional 45-60 ml of expressed human
milk. Kyle's wet diapers picked up dramatically, but he was developing
an aversion to the breast, preferring to be finger-fed. Saturday morning
we returned to the clinic. His weight was up by three ounces! The lactation
consultant was impressed he had done so well in only one day. I voiced
my concerns regarding his balking at the breast. We decided to switch
to a nursing supplementer to encourage him to nurse. Using the expressed
human milk I brought with us, the lactation consultant set up the supplementer
and we worked on Kyle's latch-on and nursing. After 20 minutes of trial
and error, he finally got the hang of it and started. A few really good
burps and he was off to sleep for several hours.

We used the nursing supplementer
at home with a lot of difficulty and few completely successful sessions.
After 24 hours of frustration for both of us, I switched back to finger
feeding with a syringe. When we went in for our weight check at 11 days
old, he had not gained any weight from the previous check, but he hadn't
lost either. Kyle was also still pinching my nipple with his nursing,
so the lactation consultant showed me how to latch him on by facing
the nipple up first so he'd take more breast with it (called an asymmetrical
latch). He had a lot of ineffective sucking, and squirting expressed
human milk into his mouth with a syringe while nursing caused him to
change his suck pattern to a more productive one. I was also instructed
to "massage" his tongue for a few seconds prior to each nursing session,
pushing down and pulling out on the tongue before latching him on. His
big sisters, Kaitlin and Breanna, also helped with his suck training
program by repeatedly sticking their tongues out at him until he would
copy them and stick his tongue out too.

I was frustrated that it
was taking so much work to train him to suck, but the lactation consultant
reminded me, "He hasn't been able to move his tongue out of his mouth
for 9 months. It's going to take more than a few days to teach him to
use it properly to nurse." The next day, I noticed Kyle was actually
sucking and swallowing while at the breast, so I started massaging the
breast while he was nursing to encourage the milk out and his swallowing
per suck ratio increased dramatically. He was still requiring about
an ounce of additional expressed human milk after nursing most of the
time, but this was major progress. At three months, Kyle is now nursing
totally independent of any supplements, and only occasionally requires
adjustment of his sucking.

I never expected my third
child to be the most difficult to breastfeed. I feel very fortunate
to have an extensive network of support from friends and family. I am
eternally grateful for a loving and supportive husband who feels as
strongly about the importance of mother's milk as I do. I am also thankful
for the support and encouragement I have received from my La Leche League
friends. Without them, I feel I may not have been able to provide my
son with the best nutrition available to him, his mommy's milk.